Despite Narcan, opioid overdoses still 'horrific' in Massachusetts

Monday

Capt. Conrad J. Prosniewski calls the growing number of fatal opioid overdoses in his community “horrific.”

The opiate-like drugs continue to kill hundreds across the Commonwealth, as the state -- like much of New England -- struggles to solve for the unrelenting public-health crisis.

“I don’t know anyone who hasn’t had this issue affect them personally in one way or another,” said Prosniewski of Salem Police. “It’s been horrific.”

In an effort to mitigate the deadly trend, Gov. Charlie Baker and other elected officials have made combating opioid addiction a top priority, which has yielded some success. Last year, opioid-related deaths fell 6.2 percent to 2,016, according to the Mass. Department of Public Health.

“It’s encouraging to see the numbers plateauing and even going down in some places,” said David R. Buchanan, chairman of the Department of Health and Policy at the University of Massachusetts Amherst. “There’s certainly been a tremendous amount of mobilization.”

The total is still nearly 50 percent more than five years ago, but nonetheless comes as a welcomed sign in a state where the last year-over-year decrease was in 2010.

The trend, however, isn’t happening everywhere, as some communities -- including Burlington, Falmouth, Gloucester, Marshfield and Shrewsbury -- continue to see the death toll climb. In Salem, Prosniewski said, 2018 overdoses and related deaths this year are keeping pace with 2017. Nearly 90 of the 351 Massachusetts cities and towns counted more deaths in 2017 compared to 2016, according to DPH.

And while many communities, including Cambridge, Fall River, Framingham, New Bedford and Taunton, have realized decreases in opioid-related deaths, the demand for opioid-related emergency services -- such as ambulance trips -- paints a less rosy picture.

“The issue here is whether we’re really cutting down on the number of people who are taking drugs,” Buchanan said.

Indeed, while the number of opioid-related deaths have decreased statewide, opioid-related calls for emergency services stayed relatively flat at 22,107 in 2017 compared to 22,417 in 2016.

It’s difficult to know exactly what’s contributing to the gap, but some believe naloxone, an overdose-reversing medication, is keeping overdoses from turning fatal, which could be affecting the numbers.

“It certainly seems reasonable to me, considering the expansion of (naloxone) programs,” Buchanan said. “The number of kits that have been distributed is huge.”

Police, firefighters and other emergency response teams are trained to administer naloxone, known best by the brand name Narcan. And anyone in Massachusetts is allowed to buy the medication at a pharmacy without a prescription.

In MetroWest, Ashland, Framingham, Hudson and Natick this year took one step further, launching a $40,000 pilot program to make 500 naloxone kits available to the general public.

Expanding access has proven an effective measure to reversing overdose deaths, but the unintended consequence may be that it’s also emboldening people with opioid addictions.

“Addicts might think, ‘Well, if my buddy is carrying Narcan, I can do what I want because he or she will get me out of this,’” Prosniewski said.

Buchanan says more preventative efforts, such as prescribing less opioids, are beginning to take form and will be needed to help fight the epidemic. Medical doctors through the first three months of the year issued about 30 percent fewer opioid prescriptions compared to the prior-year period, which dovetails with a statewide advocacy effort to stop the problem before it starts.

But a growing number of overdoses in recent years stem from fentanyl, a synthetic opioid the U.S. Drug Enforcement Administration says is 30 to 40 times more potent than heroin.

The drug, offering lucrative profit margins for traffickers, is mostly produced and sold illegally -- meaning it doesn’t require a doctor’s prescription -- and has spread fast in Massachusetts. The drug is most commonly mixed with heroin, although increasingly it’s found in cocaine, according to Prosniewski.

Nearly 85 percent of the people who died from opioids in 2017 tested positive for fentanyl, according to DPH.

“This is a new front we’re fighting,” Prosniewski said.

Opioid deaths continued to decline through the first three months of this year, falling 19.2 percent to 388 compared to the same period in 2017. The state Legislature, meanwhile, is considering a bill to further combat opioid addiction. As of July 12, the House had approved the legislation, which would expand access to care, medicine and mandate doctors to write electronic prescriptions.